Clinical Cardiology

Starting point for most heart patients to assess and present treatment options

The standard of practice for out-of-hospital defibrillation is the implantable cardioverter-defibrillator. However, much has been written and discussed about the use of automated external defibrillators. Not as much has been written about life vest wearable defibrillators. An understanding of onco-cardiology or cardio-oncology is critical for the effective care of cancer patients. Virtually all antineoplastic agents are associated with cardiotoxicity, which can be divided into 5 categories:

  • direct cytotoxic effects of chemotherapy and associated cardiac systolic dysfunction
  • cardiac ischemia
  • arrhythmias
  • pericarditis
  • chemotherapy-induced repolarization abnormalities

Radiation therapy can also lead to coronary artery disease and fibrotic changes to the valves, pericardium, and myocardium. All patients being considered for chemotherapy, especially those who have prior cardiac history, should undergo detailed cardiovascular evaluation to optimize the treatment. Serial assessment of left ventricular systolic function and cardiac biomarkers might also be considered in selected patient populations. Cardiotoxic effects of chemotherapy might be decreased by the concurrent use of angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, or beta-blockers. Antiplatelet or anticoagulation therapy might be considered in patients with a potential hypercoagulable state associated with chemotherapy or cancer. Open dialogue between both cardiologists and oncologists will be required for optimal patient care